<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<title>Insert title here</title>
</head>
<body>
<center>
<form>
<table>
<tr>
<td colspan="2" align="center" valign="top"><font size="3" face="Arial">Feedback Form :</font></td>
</tr>
<tr>
<td>User Name :</td>
<td><input type="text" name="Username"></td>
</tr>
<tr></tr>
<tr>
<td>E-mail Id :</td>
<td><input type="text" name="email"></td>
</tr>
<tr>
<td>Subject :</td>
<td><input type="text" name="subject"></td>
</tr>
<tr>
<td valign="top" >Comment :</td>
<td><textarea name="comment" rows="10" cols="50" ></textarea></td>
</tr>
</table>
</form>
</center>
</body>
</html>